These cholesterol-lowering drugs reduce heart attacks and strokes, but are they for everyone?
Forty years after statins were launched, they‘re still controversial. Researchers in Britain say fewer high-risk patients have started taking them since the latest guidance from NICE (the National Institute for Health and Care Excellence), while people in lower-risk categories may be over-treated with statins.
Why does cholesterol matter?
It is essential for digestion and making body hormones — which we manufacture from dietary fat. It circulates in the blood as LDL-cholesterol and HDL-cholesterol (attached to low/high-density lipoprotein molecules).
LDL-cholesterol (LDL-C/’bad’ cholesterol) is linked to cardiovascular disease (CVD). Cholesterol and blood-clotting cells (platelets) form deposits (plaques) that narrow artery linings, restrict blood flow and can become inflamed and/or rupture, triggering a heart attack, stroke, kidney damage, sight loss or gangrene. However, high HDL (‘good’) cholesterol can protect by helping the body’s natural cholesterol reduction system.
Our cholesterol patterns are affected by our genes, diet, lifestyle, some medication, thyroid, kidney and other diseases. Children in high-risk families should be tested.
What should my cholesterol be?
Ideally, your total cholesterol (TC) level should be under 5 and your LDL-C under 3 (all values in mmol/litre), while your HDL-C should be over 1.2 (1.0 for men). Doctors use your TC divided by your HDL-C (‘ratio’) to calculate your CVD risk.
If you already have CVD (for example, angina), current recommendations say you should be offered statin treatment, so that your TC and LDL-C levels are less than 4 and 2 mmol/ litre. This also applies to people with diabetes.
There’s no actual target for the rest of us. Instead, our risk is assessed using the QRISK2 calculator, which takes into account our age, sex, blood pressure, family history and whether we have diabetes, an irregular heartbeat, chronic kidney disease or rheumatoid arthritis. If our risk of developing CVD in the next 10 years is greater than 10%, we are advised important lifestyle changes (listed below) and offered statin treatment (primary prevention).
Pros and cons
Statins lower cholesterol levels and may reduce inflammation, too. They cut the risk of heart attacks and other types of cardiovascular disease and may help to protect against some forms of dementia and other conditions, but aren’t licensed for this. The low threshold for primary prevention means treating many people who might not develop CVD, so perhaps only one in 50 will benefit and some doctors believe they don’t benefit very elderly people.
Statins do have side effects, including muscle pain (do tell your doctor as this can be indicative of something more serious), headaches, sleep disturbance and digestive upset. Recent research confirms they can trigger diabetes, another risk factor for CVD and liver inflammation.
5 Ways To Improve Your CVD Risk
- Eat less saturated fat-processed foods, cakes, biscuits, hard cheese, sausages and pies. Eat more unsaturated fat – oily fish (such as salmon), avocado, nuts, seeds and olive oil.
- Eat more wholegrains, fruit, veg and soluble fibre (apples, oats) and less sugar.
- Exercise for 30 minutes, five times a week to maintain a healthy weight, blood pressure and arteries.
- Aim for at least six hours of sleep – too little is linked to obesity, CVD and diabetes.
- Don’t smoke or drink alcohol and only within recommended limits.
E248 – Statins and Diabetes – www.diabetic.today